Gluteal tendinopathy is often misdiagnosed and treated with a passive rather than an active approach. We explain the latest research and best practice.
Written by Katsu Inoue, Physiotherapist at The Joint Physio
We regularly come across patients experiencing pain in the side of their hip while bending, squatting, lying on the affected side or sitting and walking for some time. Our patients commonly describe that the pain is worse in the morning and then it ‘warms up’ during the day, however it starts to hurt again towards the end of the day. In most cases, patients don’t recall what originally caused their hip to start hurting.
Traditionally, a case like this was diagnosed as ‘bursitis’ in the hip (trochanteric bursitis). This is when a bursa – a pouch of fluid to nourish and lubricate tendons attaching onto bone – becomes inflamed. Patients with this diagnosis are often referred by their GP for a local steroid injection into the bursa and they are told that no other treatment is required.
However, as experts begin to understand the pathophysiology behind this condition, they have realised that pain is more closely associated with overloading of the underlying gluteal tendons. While tendinopathy and bursitis often coexist together, the injection therapy alone doesn’t address the tendon pathology. It’s no wonder why many patients present to us and say the injection was only effective for a few weeks!
Only this year, a rigorous clinical trial on effectiveness of exercise therapy for gluteal tendinopathy was released. It concluded that a combination of patient education about the pathology, exercise and steroid injection resulted in superior functional outcomes than injection alone or no treatment at 8 and 52 week follow up. So yes, a physio definitely has an important role in managing this particular condition.
At The Joint Physio, we will conduct a thorough assessment to address potential contributing factors in the development of gluteal tendinopathy, not just a symptom. These may include:
- Muscle imbalances
- Muscle weakness
- Lack of body awareness/control
- Joint stiffness in lower back, hips, knees and ankles
- Exercise/training load and technique
If you have or know someone with niggling hip pain that’s not going away, arrange an appointment to see one of our team members.